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General NPI Number Information
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NPI Number | 1952836736
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Entity Type | Organization
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Legal Business Name | BLUE FOUNTAIN II HOME CARE, LLC.
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 1309 SEQUOIA RD NW
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City | PALM BAY
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State | FL
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Zip | 32907-2781
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Country | US
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Telephone | 954-559-3265
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 SEQUOIA RD NW
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City | PALM BAY
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State | FL
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Zip | 32907-2780
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MAGDA DELINOIS
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Credential |
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Telephone | 954-559-3265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL13000
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License Number State | FL
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